PT - JOURNAL ARTICLE AU - Nicola Ullmann AU - Giulia Ceglie AU - Maria Giovanna Paglietti AU - Sergio Bottero AU - Renato Cutrera TI - Unusual cause of dyspnoea AID - 10.1136/archdischild-2017-313059 DP - 2018 Dec 01 TA - Archives of disease in childhood - Education & practice edition PG - 300--301 VI - 103 IP - 6 4099 - http://ep.bmj.com/content/103/6/300.short 4100 - http://ep.bmj.com/content/103/6/300.full SO - Arch Dis Child Educ Pract Ed2018 Dec 01; 103 AB - A 4-year-old boy was admitted to our department with fever, cough and dyspnoea, unresponsive to salbutamol and antibiotic therapy. He had previously contracted bronchiolitis at 20 days of life, followed by intermittent episodes of wheeze that never required hospitalisation and responded to short inhaled corticosteroid cycles. He had an atopic family history. On examination, he had dyspnoea, persistent cough with bronchospasm but normal oxygen saturations. Bloods showed elevated eosinophils (2004 µL), a slightly elevated C-reactive protein (1.5 mg/dL) and total IgE (326 kU/L), and specific IgE was raised for various inhalant allergens (box). A chest X-ray was performed (figure 1).Box Positive inhalant allergens Anthoxanthum odoratum Cynodon dactylon Dactylis glomerata Dermatophagoides farinae Dermatophagoides pteronissimus Holcus lanatus Poa pratensis Phleum pratense Figure 1 Chest X-ray of the patient.Questions 1. What does the chest X-ray in figure 1 show? interstitial pneumoniapneumothoraxlung atelectasis with mild mediastinal shiftdiffuse air trappingenlargement of right hilar lymph nodesQuestions 2. Given the clinical picture and the chest X-ray, what would your differential diagnosis include from the following? plastic bronchitis (PB)mycoplasma infectiontuberculosisforeign body aspirationlung perforation 3. Are any of these conditions not associated with a specific type of cast/PB? Fontan procedurehaemophilialymphatic abnormalitiesasthma and other allergic disorderssickle cell disease.